ORDO II.
Decreased Irritation.
GENUS I.
With decreased Action of the Sanguiferous System.
The reader should be here apprized, that the words strength and debility, when applied to animal motions, may properly express the quantity of resistance such motions may overcome; but that, when they are applied to mean the susceptibility or insusceptibility of animal fibres to motion, they become metaphorical terms; as in Sect. XII. 2. 1. and would be better expressed by the words activity and inactivity.
There are three sources of animal inactivity; first, the defect of the natural quantity of stimulus on those fibres, which have been accustomed to perpetual stimulus; as the arterial and secerning systems. When their accustomed stimulus is for a while intermitted, as when snow is applied to the skin of the hands, an accumulation of sensorial power is produced; and then a degree of stimulus, as of heat, somewhat greater than that at present applied, though much less than the natural quantity, excites the vessels of the skin into violent action. We must observe, that a deficiency of stimulus in those fibres, which are not subject to perpetual stimulus, as the locomotive muscles, is not succeeded by accumulation of sensorial power; these therefore are more liable to become permanently inactive after a diminution of stimulus; as in strokes of the palsy, this may be called inactivity from defect of stimulus.
2. A second source of animal inactivity exists, when the sensorial power in any part of the system has been previously exhausted by violent stimuli; as the eyes after long exposure to great light; or the stomach, to repeated spirituous potation; this may be termed inactivity from exhaustion of sensorial power. See Sect. XII. 2. 1.
3. But there is a third source of inactivity owing to the deficient production of sensorial power in the brain; and hence stimuli stronger than natural are required to produce the accustomed motions of the arterial system; in this case there is no accumulation of sensorial power produced; as in the inactivity owing to defect of stimulus; nor any previous exhaustion of it, as in the inactivity owing to excess of stimulus.
This third kind of inactivity causes many of the diseases of this genus; which are therefore in general to be remedied by such medicines as promote a greater production of sensorial power in the brain; as the incitantia, consisting of wine, beer, and opium, in small repeated quantities; and secondly of such as simply stimulate the arterial and glandular system into their natural actions; as small repeated blisters, spices, and essential oils. And lastly the sorbentia, which contribute to supply the more permanent strength of the system, by promoting the absorption of nourishment from the stomach, and intestines; and of the superfluous fluid, which attends the secretions.
SPECIES.
1. Febris inirritativa. Inirritative fever. This is the typhus mitior, or nervous fever of some writers; it is attended with weak pulse without inflammation, or symptoms of putridity, as they have been called. When the production of sensorial power in the brain is less than usual, the pulse becomes quick as well as weak; and the heart sometimes trembles like the limbs of old age, or of enfeebled drunkards; and when this force of the contractions of the heart and arteries is diminished, the blood is pushed on with less energy, as well as in less quantity, and thence its stimulus on their sides is diminished in a duplicate ratio. In compressions of the brain, as in apoplexy, the pulse becomes slower and fuller; for in that disease, as in natural sleep, the irritative motions of the heart and arteries are not diminished, volition alone is suspended or destroyed.
If the absorption of the terminations of the veins is not equally impaired with the force of the heart and arteries, the blood is taken up by the veins the instant it arrives at their extremities; the capillary vessels are left empty, and there is less resistance to the current of the blood from the arteries; hence the pulse becomes empty, as well as weak and quick; the veins of the skin are fuller than the arteries of it; and its appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1.
When this pulse persists many hours, it constitutes the febris inirritativa, or typhus, or nervous fever, of some writers; it is attended with little heat, the urine is generally of a natural colour, though in less quantity; with great prostration of strength, and much disturbance of the faculties of the mind. Its immediate cause seems to be a deficient secretion of the sensorial power from the inaction of the brain; hence almost the whole of the sensorial power is expended in the performance of the motions necessary to life, and little of it can be spared for the voluntary actions of the locomotive muscles, or organs of sense, see Class I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some other part of the body; as of the spleen, when a tumour is felt on the left side, as in some intermittents; or of the kidnies, when the urine continues pale and in small quantity. Does the revivescence of these affected parts, or their torpor, recurring at intervals, form the paroxysms of these fevers? and their permanent revivescence establish the cure? See Class IV. 2. 1. 19.
M. M. Wine and opium in small quantities repeated every three hours alternately; small repeated blisters; warm but fresh air; sorbentia; nutrientia; transfusion of blood. Small electric shocks passed through the brain in all directions. Oxygene air?
2. Paresis inirritativa. Inirritative debility. A defective action of the irritative motions without increase of the frequency of the pulse. It continues three or four weeks like a fever, and then either terminates in health, or the patient sinks into one kind of apoplexy, and perishes. Many symptoms, which attend inirritative fevers, accompany this disease, as cold hands and feet at periodic times, scurf on the tongue, want of appetite, muddy urine, with pains of the head, and sometimes vertigo, and vomiting.
This disease differs from the inirritative fever by the pulse not being more frequent than in health. The want of appetite and of digestion is a principal symptom, and probably is the cause of the universal debility, which may be occasioned by the want of nourishment. The vertigo is a symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine is owing to increased absorption from the bladder in consequence of the diminished cutaneous and cellular absorption, as in anasarca, explained in Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of that part of the system; the foul tongue is owing to an increased absorption of the thinner part of the mucus in consequence of the general deficiency of fluid, which should be absorbed by the skin and stomach. The sickness is owing to decreased action of the stomach, which is probably the primary disease, and is connected with the vertigo.
M. M. An emetic. Calomel, grains iv. once or twice. Then a blister. Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small quantities, repeated alternately every three hours. Small electric percussions through the stomach.
3. Somnus interruptus. Interrupted sleep. In some fevers, where the inirritability is very great, when the patient falls asleep, the pulse in a few minutes becomes irregular, and the patient awakes in great disorder, and fear of dying, refusing to sleep again from the terror of this uneasy sensation. In this extreme debility there is reason to believe, that some voluntary power during our waking hours is employed to aid the irritative stimuli in carrying on the circulation of the blood through the lungs; in the same manner as we use voluntary exertions, when we listen to weak sounds, or wish to view an object by a small light; in sleep volition is suspended, and the deficient irritation alone is not sufficient to carry on the pulmonary circulation. This explanation seems the most probable one, because in cases of apoplexy the irritative motions of the arterial system do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13.
M. M. Opium in very small doses, as three drops of laudanum. A person should watch the patient, and awaken him frequently; or he should measure the time between slumber and slumber by a stop-watch, and awaken the patient a little before he would otherwise awake; or he should keep his finger on the pulse, and should forcibly awaken him, as soon as it becomes irregular, before the disorder of the circulation becomes so great as to disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2.
4. Syncope. Fainting consists in the decreased action of the arterial system; which is sometimes occasioned by defect of the stimulus of distention, as after venesection, or tapping for the dropsy. At other times it arises from great emotions of the mind, as in sudden joy or grief. In these cases the whole sensorial power is exerted on these interesting ideas, and becomes exhausted. Thus during great surprise or fear the heart stops for a time, and then proceeds with throbbing and agitation; and sometimes the vital motions become so deranged, as never to recover their natural successive action; as when children have been frightened into convulsions. See Sect. XII. 7. 1.
Miss ——, a young lady of Stafford, in travelling in a chaise was so affected by seeing the fall of a horse and postillion, in going down a hill, though the carriage was not overturned, that she fainted away, and then became convulsed, and never spoke afterwards; though she lived about three days in successive convulsions and stupor.
5. Hæmorrhagia venosa. A bleeding from the capillaries arising from defect of venous absorption, as in some of those fevers commonly termed putrid. When the blood stagnates in the cellular membrane, it produces petechiæ from this torpor or paralysis of the absorbent mouths of the veins. It must be observed, that those people who have diseased livers, are more liable to this kind of hæmorrhages, as well as to the hæmorrhagia arteriosa; the former, because patients with diseased livers are more subject to paralytic complaints in general, as to hemiplegia, and to dropsy, which is a paralysis of the lymphatics; and the latter is probably owing to the delay of the circulation in the vena porta by the torpor of this hepatic vessel, when the liver is not much enlarged; and to its pressure on the vena cava, when it is much enlarged.
M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel dissolved in spirit of wine externally. Flour.
6. Hæmorrhois cruenta. In the bleeding piles the capillary vessels of the rectum become distended and painful from the defect of the venous absorption of the part, and at length burst; or the mucous glands are so dilated as to give a passage to the blood; it is said to observe lunar periods.
M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia. External compression by applying lint, sponge, or cotton. Internal compression by applying a bit of candle smeared with mercurial ointment. Strangulate the tumid piles with a silk string. Cut them off. See Class I. 2. 3. 22.
Mrs. —— had for twelve or fifteen years, at intervals of a year or less, a bleeding from the rectum without pain; which however stopped spontaneously after she became weakened, or by the use of injections of brandy and water. Lately the bleeding continued above two months, in the quantity of many ounces a day, till she became pale and feeble to an alarming degree. Injections of solutions of lead, of bark and salt of steel, and of turpentine, with some internal astringents, and opiates, were used in vain. An injection of the smoke of tobacco, with ten grains of opium mixed with the tobacco, was used, but without effect the two first times on account of the imperfection of the machine; on the third time it produced great sickness, and vertigo, and nearly a fainting fit; from which time the blood entirely stopped. Was this owing to a fungous excrescence in the rectum; or to a blood-vessel being burst from the difficulty of the blood passing through the vena porta from some hepatic obstruction, and which had continued to bleed so long? Was it stopped at last by the fainting fit? or by the stimulus of the tobacco?
7. Hæmorrhagia renum. Hæmorrhage from the kidnies, when attended with no pain, is owing to defect of venous absorption in the kidney. When attended with pain on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney; which is a much more frequent disease than the former. See Sect. XXVII. 1.
M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate; cold immersion up to the navel, the upper part of the body being kept cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent liquids. Cool dress. Cool bed-room.
Cows are much subject to bloody urine, called foul water by the farmers; in this disease about sixty grains of opium with or without as much rust of iron, given twice a day, in a ball mixed with flour and water, or dissolved in warm water, or warm ale, is, I believe, an efficacious remedy, to which however should be added about two quarts of barley or oats twice a day, and a cover at night, if the weather be cold.
8. Hæmorrhagia Hepatis. Hæmorrhage from the liver. It sometimes happens in those, who have the gutta rosea, or paralytic affections owing to diseased livers induced by the potation of fermented liquors, that a great discharge of black viscid blood occasionally comes away by stool, and sometimes by vomiting: this the ancients called Melancholia, black bile. If it was bile, a small quantity of it would become yellow or green on dilution with warm water, which was not the case in one experiment which I tried; it must remain some time in the intestines from its black colour, when it passes downwards, and probably comes from the bile-ducts, and is often a fatal symptom. When it is evacuated by vomiting it is less dangerous, because it shews greater remaining irritability of the intestinal canal, and is sometimes salutary to those who have diseased livers.
M. M. An emetic. Rhubarb, steel, wine, bark.
9. Hæmoptoe venosa. Venous hæmoptoe frequently attends the beginning of the hereditary consumptions of dark-eyed people; and in others, whose lungs have too little irritability. These spittings of blood are generally in very small quantity, as a tea-spoonful; and return at first periodically, as about once a month; and are less dangerous in the female than in the male sex; as in the former they are often relieved by the natural periods of the menses. Many of these patients are attacked with this pulmonary hæmorrhage in their first sleep; because in feeble people the power of volition is necessary, besides that of irritation, to carry on respiration perfectly; but, as volition is suspended during sleep, a part of the blood is delayed in the vessels of the lungs, and in consequence effused, and the patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II. 1. 6. 6. III. 2. 1. 10.
M. M. Wake the patient every two or three hours by an alarum clock. Give half a grain of opium at going to bed, or twice a day. Onions, garlic, slight chalybeates. Issues. Leeches applied once a fortnight or month to the hemorrhoidal veins to produce a new habit. Emetics after each period of hæmoptoe, to promote expectoration, and dislodge any effused blood, which might by remaining in the lungs produce ulcers by its putridity. A hard bed, to prevent too sound sleep. A periodical emetic or cathartic once a fortnight.
10. Palpitatio cordis. The palpitation of the heart frequently attends the hæmoptoe above mentioned; and consists in an ineffectual exertion of the heart to push forwards its contents in due time, and with due force. The remote cause is frequently some impediment to the general circulation; as the torpor of the capillaries in cold paroxysms of fever, or great adhesions of the lungs. At other times it arises from the debility of the action of the heart owing to the deficient sensorial power of irritation or of association, as at the approach of death.
In both these cases of weak exertion the heart feels large to the touch, as it does not completely empty itself at each contraction; and on that account contracts more frequently, as described in Sect. XXXII. 2. 2. Another kind of palpitation may sometimes arise from the retrograde motions of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.
11. Menorrhagia. Continued flow of the catamenia. The monthly effusion of blood from the uterus or vagina is owing to a torpor of the veins of those membranes in consequence of the defect of venereal stimulus; and in this respect resembles the mucus discharged in the periodical venereal orgasm of the female quadrupeds, which are secluded from the males. The menorrhagia, or continued flow of this discharge, is owing to a continued defect of the venous absorption of the membranes of the uterus or vagina. See Class IV. 2. 4. 7.
M. M. Venesection in small quantity. A cathartic. Then opium, a grain every night. Steel. Bark. A blister. Topical aspersion with cold water, or cold vinegar.
12. Dysmenorrhagia. A difficulty of menstruation attended with pain. In this complaint the torpor of the uterine vessels, which precedes menstruation, is by sympathy accompanied with a torpor of the lumbar membranes, and consequent pain; and frequently with cold extremities, and general debility. The small quantity and difficulty of the discharge is owing to arterial inactivity, as in chlorosis. Whence it happens, that chalybeate medicines are of efficacy both to stop or prevent too great menstruation, and to promote or increase deficient menstruation; as the former is owing to inirritability of the veins, and the latter of the arteries of the uterus. See Article IV. 2. 6. in the Materia Medica.
M. M. Opium, steel, pediluvium. Warm bath.
13. Lochia nimia. Too great discharge after delivery. In that unnatural practice of some hasty accoucheurs of introducing the hand into the uterus immediately after the delivery of the child, and forcibly bringing away the placenta, it frequently happens, that a part of it is left behind; and the uterus, not having power to exclude so small a portion of it, is prevented from complete contraction, and a great hæmorrhage ensues. In this circumstance a bandage with a thick compress on the lower part of the belly, by appressing the sides of the uterus on the remaining part of the placenta, is likely to check the hæmorrhage, like the application of a pledget of any soft substance on a bleeding vessel.
In other cases the lochia continues too long, or in too great quantity, owing to the deficiency of venous absorption.
M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark. Clothes dipped in cold vinegar and applied externally. Bandages on the limbs to keep more blood in them for a time have been recommended.
14. Abortio spontanea. Some delicate ladies are perpetually liable to spontaneous abortion, before the third, or after the seventh, month of gestation. From some of these patients I have learnt, that they have awakened with a slight degree of difficult respiration, so as to induce them to rise hastily up in bed; and have hence suspected, that this was a tendency to a kind of asthma, owing to a deficient absorption of blood in the extremities of the pulmonary or bronchial veins; and have concluded from thence, that there was generally a deficiency of venous absorption; and that this was the occasion of their frequent abortion. Which is further countenanced, where a great sanguinary discharge precedes or follows the exclusion of the fetus.
M. M. Opium, bark, chalybeates in small quantity. Change to a warmer climate. I have directed with success in four cases half a grain of opium twice a day for a fortnight, and then a whole grain twice a day during the whole gestation. One of these patients took besides twenty grains of Peruvian bark for several weeks. By these means being exactly and regularly persisted in, a new habit became established, and the usual miscarriages were prevented.
Miscarriages more frequently happen from eruptive fevers, and from rheumatic ones, than from other inflammatory diseases. I saw a most violent pleurisy and hepatitis cured by repeated venesection about a week or ten days before parturition; yet another lady whom I attended, miscarried at the end of the chicken pox, with which her children were at the same time affected. Miscarriages towards the termination of the small pox are very frequent, yet there have been a few instances of children, who have been born with the eruption on them. The blood in the small pox will not inoculate that disease, if taken before the commencement of the secondary fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is not yet formed, but after it has been oxygenated through the cuticle in the pustules, it becomes contagious; and if it be then absorbed, as in the secondary fever, the blood of the mother may become contagious, and infect the child. The same mode of reasoning is applicable to the chicken pox. See Class IV. 3. 1. 7.
15. Scorbutus. Sea-scurvy is caused by salt diet, the perpetual stimulus of which debilitates the venous and absorbent systems. Hence the blood is imperfectly taken up by the veins from the capillaries, whence brown and black spots appear upon the skin without fever. The limbs become livid and edematous, and lastly ulcers are produced from deficient absorption. See Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of the lungs, see Sect. XXVII. 2.
M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar. Wine. Steel. Bark. Sorbentia. Opium?
16. Vibices. Extravasations of blood become black from their being secluded from the air. The extravasation of blood in bruises, or in some fevers, or after death in some patients, especially in the parts which were exposed to pressure, is owing to the fine terminations of the veins having been mechanically compressed so as to prevent their absorbing the blood from the capillaries, or to their inactivity from disease. The blood when extravasated undergoes a chemical change before it is sufficiently fluid to be taken up by the lymphatic absorbents, and in that process changes its colour to green and then yellow.
17. Petechiæ. Purple spots. These attend fevers with great venous inirritability, and are probably formed by the inability of a single termination of a vein, whence the corresponding capillary becomes ruptured, and effuses the blood into the cellular membrane round the inert termination of the vein. This is generally esteemed a sign of the putrid state of the blood, or that state contrary to the inflammatory one. As it attends some inflammatory diseases which are attended with great inirritability, as in the confluent small pox. But it also attends the scurvy, where no fever exists, and it therefore simply announces the inactivity of the terminations of some veins; and is thence indeed a bad symptom in fevers, as a mark of approaching inactivity of the whole sanguiferous system, or death. The blue colour of some children's arms or faces in very cold weather is owing in like manner to the torpor of the absorbent terminations of the veins, whence the blood is accumulated in them, and sometimes bursts them.